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Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy: a randomized-controlled trial

Tseng, Chih-Weia,c; Koo, Malcolmb,d; Hsieh, Yu-Hsia,c

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1296–1302
doi: 10.1097/MEG.0000000000000954
Original Articles: Endoscopy

Background and aim The water exchange (WE) method can decrease the discomfort of the patients undergoing colonoscopy. It also provides salvage cleansing and improves adenoma detection, but a longer intubation time is required. Cap-assisted colonoscopy leads to a significant reduction in cecal intubation time compared with traditional colonoscopy with air insufflation. The aim of this study was to investigate whether combined cap-assisted colonoscopy and water exchange (CWE) could decrease the cecal intubation time compared with WE.

Patients and methods A total of 120 patients undergoing fully sedated colonoscopy at a regional hospital in southern Taiwan were randomized to colonoscopy with either CWE (n=59) or WE (n=61). The primary endpoint was cecal intubation time.

Results The mean cecal intubation time was significantly shorter in CWE (12.0 min) compared with WE (14.8 min) (P=0.004). The volume of infused water during insertion was lower in CWE (840 ml) compared with WE (1044 ml) (P=0.003). The adenoma detection rate was 50.8 and 47.5% for CWE and WE, respectively (P=0.472). The Boston Bowel Preparation Scale scores were comparable in the two groups. Results from the multiple linear regression analysis indicated that WE with a cap, a higher degree of endoscopist’s experience, a higher Boston Bowel Preparation Scale score, and a lower volume of water infused during insertion, without abdominal compression, without change of position, and without chronic laxative use, were significantly associated with a shorter cecal intubation time.

Conclusion In comparison with WE, CWE could shorten the cecal intubation time and required lower volume of water infusion during insertion without compromising the cleansing effect of WE.

Departments of aInternal Medicine, Division of Gastroenterology

bMedical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi

cSchool of Medicine, Tzu Chi University, Hualien City, Taiwan

dDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Correspondence to Yu-Hsi Hsieh, MD, Department of Medicine, Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi 62247, Taiwan Tel/fax: +886 5264 8000; e-mail:

Received May 22, 2017

Accepted July 3, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.